Surgical management of spasmodic torticollis

Abstract

IntroductionSpasmodic torticollis (ST) is a neuromuscular disorder characterized by uncontrolled clonic and intermittently tonic spasm of the neck muscles. ObjectiveThis retrospective study was done to study clinical picture and to evaluate the surgical results of different surgical procedures in 11 patients who had spasmodic torticollis. MethodsThe male to female ratio was 1–2 (4 males and 7 females) and their ages ranged from 18 to 65years. The X-ray of the cervical spine was performed before the operation to exclude cervical disorders that can cause symptoms similar to spasmodic torticollis. MRI of the head and neck was performed in all patients, without finding significant brain lesions. Electromyography of the cervical muscles was performed preoperatively and postoperatively. All cases underwent surgery in the form of variable combinations of ventral rhizotomy of C1, C2+ selective peripheral denervation of neck muscles involved according to the type of torticollis. Mean postoperative follow up period was 24months. ResultsThere was no operative mortality. As regards the morbidity, one patient had deficiency of shoulder elevation that was transient and improved after 3months; one patient had wound infection that responded well to antibiotics after culture and sensitivity. Postoperative dysphagia was found in two cases that improved in one of them after two months. At the last follow up examination period, excellent results were obtained in 55% of patients, good results in 18% of patients, fair results in 18% of patients, and poor results in 9% of cases. ConclusionThere is no standard surgical procedure for treatment of ST; this is adapted to each patient according to type of torticollis. Better results were obtained in simple torticollis (excellent results in 100%), than in complex type (excellent and good results in 33.3%).